Provider Demographics
NPI:1336510106
Name:WAGERS FAMILY EYE CARE PC
Entity Type:Organization
Organization Name:WAGERS FAMILY EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:WAGERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-606-0101
Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47448-0331
Mailing Address - Country:US
Mailing Address - Phone:812-606-0101
Mailing Address - Fax:
Practice Address - Street 1:51 E. CHESTNUT ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NASHVILLE
Practice Address - State:IN
Practice Address - Zip Code:47448
Practice Address - Country:US
Practice Address - Phone:812-606-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003598152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty